A MAN died during a routine operation after surgeons got into difficulty and found the specialist they needed had been suspended without their knowledge, an inquest heard.

Gerald Storey, of at the Lonsdale Hotel Addiscombe Road, died aged 63 after having a cardiac arrest on June 9, 2011, during a routine angioplasty at Croydon University Hospital (CUH).

His cardiologist consultant, Dr Kevin Beatt, told the court bad management in the department had led to the “one in several million chance” situation of his patient dying, saying “I have never heard of this or experienced this before in my career”.

The evidence revolved around a senior specialist nurse, Sister Lucy Jones, who was integral to the operation but was suspended by managers, who then failed to tell the relevant doctors before the procedure began that she would be absent.

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Dr Beatt told the court that, had he known Sister Jones would not be available, he would “not have gone forward with this operation”.

“I believe the suspension of Lucy Jones and the management’s failure to tell me this as I operated on Mr Storey directly contributed to his death,” he said.

The doctor told the court the laboratory descended into “chaos” when the operation ran into complications and it became apparent that Sister Jones was not there. Not only did the second-in command nurse have to leave in tears to compose herself after hearing of Sister Jones’ suspension and later injured herself on a surgical needle, but at one point Dr Beatt was left without any appropriately-trained nurses for about 20 minutes.

Mr Storey ended up going into cardiac arrest and dying on the operating table, despite the efforts of resuscitation team.

“She (Lucy Jones) was the only nurse with the expertise to organise the laboratory and the only one who knew where the right equipment was,” said Dr Beatt. “I think the time wasted led to my patient’s death.”

They told the court they had no choice but to suspend Sister Lynch at the time and were assured the procedure was safe to go ahead without her.

According to Mark Kemp, the associate director of operations at the time, Sister Jones was suspended for not responding to written management requests and for her uncooperative behaviour towards staff.

“Sister Jones seemed unable to deliver reasonable management requests and she was rude and discourteous to management,” he said.

He had been visited by Wendy Riddle and Sinead Lynch after meeting which ended in a “shouting match” between themselves, Sister Jones and Dr Beatt. Mark Kemp, the matron and a member of human resources then decided to suspend her after hearing details of the meeting and Sister Jones’ previous behaviour.

VERDICT

Coroner Roy Palmer this week delivered a narrative verdict, saying: “There were corridor conversations, but nothing was written down and a decision was made to suspend Lucy Jones.

“The absence of Lucy Jones did contribute to the outcome and more things would have been done more quickly if she had been there.”

The coroner issued a rule 43 order – a statement to relevant authorities demanding they reform issues thrown up in a case to prevent further deaths.

The Trust was represented by Stuart Knowles, the former member of Stafford Hospital's legal team who was accused of suppressing information to an inquest over the 2006 death of John Moore-Robinson but later cleared.

ALLEGATIONS

Dr Beatt argued in court Mr Knowles had acknowledged in the past his duty to withhold information if it was in the interests of the Trust he was representing.

When the coroner said he was deeply unhappy with this possibility, Mr Knowles said he had disclosed all the relevant information. Dr Beatt, again, questioned whether information in the Trust had been supressed.

He also caused outcry in the court when he responded to Wendy Riddle’s allegations against Sister Jones of bullying, by saying: “"There were no accusations made against Sister Jones until she raised concerns about Dr Asif Qasim. It is common practice that if someone criticises management, they have allegations made against them - are you not aware of the Mid Staffordshire report?"

Rule 43

Once a Rule 43 is submitted, the NHS will have 28 days to respond. It is likely the issue will be referred to the Care Quality Commission.